OALibJ  Vol.2 No.1 , January 2015
Trigger Point Infiltrations into the Temporal Muscles of Patients with Fibromyalgia and Headaches: A Randomized, Double-Blinded and Controlled Study
Abstract: Aims: To compare the therapeutic effect of blocking trigger points in temporal muscles by using saline and an anesthetic agent among patients with masticatory myofascial pain syndrome, fibromyalgia and headaches and with non-infiltrated controls. Methods: One hundred women, aged 23 to 70 years old, were initially triaged. The seventy patients who experienced at least one trigger point in the temporal muscles were randomly divided into three groups, as follows: saline infiltration, anesthetic infiltration and control (non-infiltrated). Results: All of the patients with cranio cervical pain confirmed the presence of a headache. Temporal muscle tenderness occurred in 90% of patients, and 93% to 98% of the trigger points of the temporal muscles caused headache upon palpation. There was reduced facial pain intensity in 87.71% of the patients infiltrated with saline and 100% of the patients infiltrated with an anesthetic but not in the control group. The results were similar, considering the frequency of the headache. Regarding the intensity of the headache, infiltration with the saline and the anesthetic were both effective and did not exhibit significant differences, whereas significant differences were observed in the control group. Conclusions: Patients with fibromyalgia experience pain in the orofacial region and trigger points in the temporal muscles, which trigger a headache. Treatment with infiltration decreases facial pain and the frequency and intensity of headaches. There were no differences in treatment in terms of the infiltrated substance that was administered.
Cite this paper: Sabatke, S. , Scola, R. , Paiva, E. and Kowacs, P. (2015) Trigger Point Infiltrations into the Temporal Muscles of Patients with Fibromyalgia and Headaches: A Randomized, Double-Blinded and Controlled Study. Open Access Library Journal, 2, 1-9. doi: 10.4236/oalib.1100813.

[1]   Wolfe, F., Smythe, H.A., Yunus, M.B., Bennett, R.M., Bombardier, C., Goldenberg, D.L., et al. (1990) The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Arthritis & Rheumatism, 33, 160-172.

[2]   Green, S. (1999) Sleep Cycles, TDM, Fibromyalgia, and Their Relationship to Orofacial Myofunctional Disorders. International Journal of Orofacial Mycology, 25, 4-14.

[3]   Moldofsky, H.K. (2001) Disordered Sleep in Fibromyalgia and Related Myofascial Facial Pain Conditions. Dental Clinics of North America, 45, 701-713.

[4]   Wänaman, A. (1996) The Relationship between Muscle Tenderness and Craniomandibular Disorders: A Study of 35-Year-Olds from the General Population. Journal of Orofacial Pain, 10, 15-20.

[5]   Wright, E.F., Des Rosier, K.F., Clark, M.K. and Bifano, S.L. (1997) Identifying Undiagnosed Rheumatic Disorders among Patients with TMD. The Journal of the American Dental Association, 128, 738-744.

[6]   Antonelli, M.A. and Vawter, R.L. (1992) Nonarticular Pain Syndromes. Postgraduate Medical Journal, 91, 95-104.

[7]   Bendtsen, L., Jensen, R. and Olesen, J. (1996) Qualitatively Altered Nociception in Chronic Myofascial Pain. Pain, 65, 259-264.

[8]   Eriksson, P.O., Lindman, R., Stål, P. and Bengtsson, A. (1988) Symptoms and Signs of Mandibular Dysfunction in Primary Fibromyalgia Syndrome (PFS) Patients. Swedish Dental Journal, 12, 141-149.

[9]   Gerwin, R.D. (2005) A Review of Myofascial Pain and Fibromyalgia—Factors That Promote Their Persistence. Acupuncture in Medicine, 23, 121-134.

[10]   Magnusson, T. and Carlsson, G.E. (1978) Recurrent Headaches in Relation to Temporomandibular Joint Pain-Dys-function. Acta Odontologica Scandinavica, 36, 333-338.

[11]   Okeson, J.P. (2006) Dores Bucofaciais de Bell: Tratamento Clínico da dor Bucofacial [Bell’s Orofacial Pains: Clinical Treatment of Orofacial Pain]. Quintessence, São Paulo.

[12]   Couppé, C., Torelli, P., Fuglsang-Frederiksen, A., Andersen, K.V. and Jensen, R. (2007) Myofascial Trigger Points Are Very Prevalent in Patients with Chronic Tension-Type Headache. Clinical Journal of Pain, 23, 23-27.

[13]   Jensen, R., Bendtsen, L. and Olesen, J. (1998) Muscular Factors Are of Importance in Tension-Type Headache. Headache, 38, 10-17.

[14]   Calandre, E.P., Hidalgo, J., García-Leiva, J.M. and Rico-Villademoros, F. (2006) Trigger Point Evaluation in Migraine Patients: An Indication of Peripheral Sensitization Linked to Migraine Predisposition? European Journal of Neurology, 13, 244-249.

[15]   Davidoff, R.A. (1998) Trigger Points and Myofascial Pain: Toward Understanding How They Affect Headaches. Cephalalgia, 18, 436-448.

[16]   Fernández-de-Las-Peñas, C., Alonso-Blanco, C., Cuadrado, M.L., Gerwin, R.D. and Pareja, J.A. (2006) Myofascial Trigger Points and Their Relationship to Headache Clinical Parameters in Chronic Tension-Type Headache. Headache, 46, 1264-1272.

[17]   Fernández-de-Las-Peñas, C., Ge, H.Y., Arendt-Nielsen, L., Cuadrado, M.L. and Pareja, J.A. (2007) The Local and Referred Pain from Myofascial Trigger Points in the Temporalis Muscle Contributes to Pain Profile in Chronic Tension-Type Headache. Clinical Journal of Pain, 23, 786-792.

[18]   Fernández-de-las-Peñas, C., Caminero, A.B., Madeleine, P., Guillem-Mesado, A., Ge, H.Y., Arendt-Nielsen, L. and Pareja, J.A. (2009) Multiple Active Myofascial Trigger Points and Pressure Pain Sensitivity Maps in the Temporalis Muscle Are Related in Women with Chronic Tension Type Headache. Clinical Journal of Pain, 25, 506-512.

[19]   Mellick, G.A. and Mellick, L.B. (2003) Regional Head and Face Pain Relief Following Lower Cervical Intramuscular Anesthetic Injection. Headache, 43, 1109-1111.

[20]   Venancio, R.A., Alencar, F.G.P. and Zamperini, C. (2008) Different Substances and Dry-Needling Injections in Patients with Myofascial Pain and Headaches. Cranio: The Journal of Craniomandibular Practice, 26, 96-103.

[21]   Simons, D.G., Travell, J.G. and Simons, L.S. (2005) Dor e Disfunção Miofascial: Manual de Pontos-Gatilho [Myofascial Pain and Dysfunction: The Trigger Point Manual]. Artmed, Porto Alegre.

[22]   McMillan, A.S. and Blasberg, B. (1994) Pain-Pressure Threshold in Painful Jaw Muscles Following Trigger Point Injection. Journal of Orofacial Pain, 8, 384-390.

[23]   Iwama, H. and Akama, Y. (2000) The Superiority of Water-Diluted 0.25% to Neat 1% Lidocaine for Trigger-Point Injections in Myofascial Pain Syndrome: A Prospective, Randomized, Double-Blinded Trial. Anesthesia and Analgesia, 91, 408-409.

[24]   Iwama, H., Ohmori, S., Kaneko, T. and Watanabe, K. (2001) Water-Diluted Local Anesthetic for Trigger-Point Injection in Chronic Myofascial Pain Syndrome: Evaluation of Types of Local Anesthetic and Concentrations in Water. Regional Anesthesia and Pain Medicine, 26, 333-336.

[25]   Hong, C.Z., Kuan, T.S., Chen, J.T. and Chen, S.M. (1997) Referred Pain Elicited by Palpation and by Needling of Myofascial Trigger Points: A Comparison. Archives of Physical Medicine and Rehabilitation, 78, 957-960.

[26]   Garvey, T.A., Marks, M.R. and Wiesel, S.W. (1989) A Prospective, Randomized, Double-Blind Evaluation of Trigger-Point Injection Therapy for Low-Back Pain. Spine, 14, 962-964.

[27]   McClaflin, R.R. (1994) Myofascial Pain Syndrome. Postgraduate Medicine, 96, 56-73.

[28]   Hong, C. and Hsueh, T. (1996) Difference in Pain Relief after Trigger Point Injections in Myofascial Pain Patients with and without Fibromyalgia. Archives of Physical Medicine and Rehabilitation, 77, 1161-1166.

[29]   Frost, F.A., Jessen, B. and Siggaard-Andersen, J. (1980) A Control, Double-Blind Comparison of Mepivacaine Injection versus Saline Injection for Myofascial Pain. Lancet, 315, 499-501.

[30]   Alarcón, G.S. and Bradley, L.A. (1994) Coming out of the Closet: Fibromyalgia in the 1990’s: An American Perspective. Revista Brasileira de Reumatologia, 34, 49-52.

[31]   Senna, E.R., De Barros, A.L., Silva, E.O., Costa, I.F., Pereira, L.V., Ciconelli, R.M. and Ferraz, M.B. (2004) Prevalence of Rheumatic Diseases in Brazil: A Study Using the COPCORD Approach. Journal of Rheumatology, 31, 594-597.

[32]   Atra, E., Pollak, D.F. and Martinez, J.E. (1993) FM: Etiopatogenia e terapêutica [FM: Etiopathogenesis and Therapeutics]. Rev Bras Reumatol, 33, 64-72.

[33]   Olson, G.B., Savage, S. and Olson, J. (2000) The Effects of Collagen Hydrolysat on Symptoms of Chronic Fibromyalgia and Temporomandibular Joint Pain. Cranio, 18, 135-141.

[34]   Cimino, R., Michelotti, A., Stradi, R. and Farinaro, C. (1998) Comparison of Clinical and Psychologic Features of Fibromyalgia and Masticatory Myofascial Pain. Journal of Orofacial Pain, 12, 35-41.

[35]   Boomershine, C.S. and Crofford, L.J. (2009) A Symptom-Based Approach to Pharmacologic Management of Fibromyalgia. Nature Reviews Rheumatology, 5, 191-199.

[36]   Williams, D.A. and Schlling, S. (2009) Advances in the Assessment of Fibromyalgia. Rheumatic Disease Clinics of North America, 35, 339-357.

[37]   Hameroff, S.R., Crago, B.R., Blitt, C.D., Womble, J. and Kanel, J. (1981) Comparison of Bupivacaine, Etidocaine, and Saline for Trigger-Point Therapy. Anesthesia & Analgesia, 60, 752-755.

[38]   Sollecito, T.P., Stoopler, E.T., DeRossi, S.S. and Silverton, S. (2003) Temporomandibular Disorders and Fibromyalgia: Comorbid Conditions? General Dentistry, 51, 184-187.

[39]   Bohr, T. (1996) Problems with Myofascial Pain Syndrome and Fibromyalgia Syndrome. Neurology, 46, 593-597.

[40]   Fricton, J.R. (1994) Myofascial Pain. Baillière’s Clinical Rheumatology, 8, 857-880.

[41]   Wheeler, A.H. (2004) Myofascial Pain Disorders. Drugs, 64, 45-62.

[42]   Han, S. and Harrison, P. (1997) Myofascial Pain Syndrome and Trigger-Point Management. Regional Anesthesia and Pain Medicine, 22, 89-101.

[43]   Cummings, T.M. and White, A.R. (2001) Needling Therapies in the Management of Myofascial Trigger Point Pain: A Systematic Review. Archives of Physical Medicine and Rehabilitation, 82, 986-992.

[44]   Carlson, C.R., Okeson, J.P., Falace, D.A., Nitz, A.J. and Lindroth, J.E. (1993) Reduction of Pain and EMG Activity in the Masseter Region by Trapezius Trigger Point Injection. Pain, 55, 397-400.

[45]   Jaeger, B. and Skootsky, S.A. (1987) Double-Blind Controlled Study of Different Myofascial Trigger Point Injection Techniques. Pain, 292, 560.

[46]   Hong, C. (1994) Lidocaine Injection versus Dry Needling to Myofascial Trigger Point: The Importance of the Local Twitch Response. American Journal of Physical Medicine & Rehabilitation, 73, 256-263.

[47]   McMillan, A.S., Nolan, A. and Kelly, P.J. (1997) The Efficacy of Dry Needling and Procaine in the Treatment of Myofascial Pain in the Jaw Muscles. Journal of Orofacial Pain, 11, 307-314.

[48]   Goldenberg, D.L., Burckhardt, C. and Crofford, L. (2004) Management of Fibromyalgia Syndrome. Journal of the American Medical Association, 292, 2388-2395.

[49]   Littlejohn, G.O. (2004) Balanced Treatments for Fibromyalgia. Arthritis & Rheumatism, 50, 2725-2729.

[50]   Oliveira, W. (2002) Disfunçães Temporomandibulares [Temporomandibular Disorders]. Artes Médicas, São Paulo.